Fury Matthew S, Paschos Nikolaos K, Fabricant Peter D, Anderson Christian N, Busch Michael T, Chambers Henry G, Christino Melissa A, Cordasco Frank A, Edmonds Eric W, Ganley Theodore J, Green Daniel W, Heyworth Benton E, Lawrence J Todd R, Matava Matthew J, Micheli Lyle J, Milewski Matthew D, Nepple Jeffrey J, Parikh Shital N, Pennock Andrew T, Perkins Crystal A, Saluan Paul M, Shea Kevin G, Wall Eric J, Willimon Samuel C, Kocher Mininder S
Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA.
Investigation performed at Boston Children's Hospital, Boston, Massachusetts, USA.
Am J Sports Med. 2022 Apr;50(5):1430-1441. doi: 10.1177/03635465211008656. Epub 2021 May 13.
Growth disturbance is an uncommon but potentially serious complication after anterior cruciate ligament (ACL) reconstruction in skeletally immature patients.
To describe how the pediatric ACL literature has assessed preoperative skeletal maturity and the amount of growth remaining and to comprehensively review the incidence, reporting, and monitoring of postoperative growth disturbance.
Systematic review; Level of evidence, 4.
This review included studies reporting original research of clinical outcomes of skeletally immature patients after ACL reconstruction. Patient characteristics, surgical techniques, preoperative assessments of skeletal maturity or growth remaining, and postoperative assessments of growth disturbances were extracted.
A total of 100 studies met inclusion criteria. All studies reported chronological age, and 28 studies (28%) assessed skeletal age. A total of 44 studies (44%) used Tanner staging, and 12 studies (12%) obtained standing hip-to-ankle radiographs preoperatively. In total, 42 patients (2.1%) demonstrated a leg length discrepancy (LLD) >10 mm postoperatively, including 9 patients (0.5%) with LLD >20 mm; furthermore, 11 patients (0.6%) with LLD underwent growth modulation. Shortening was the most common deformity overall, but overgrowth was reported more frequently in patients who had undergone all-epiphyseal techniques. Most LLDs involved the femur (83%). A total of 26 patients (1.3%) demonstrated a postoperative angular deformity ≥5°, and 9 of these patients underwent growth modulation. The most common deformities were femoral valgus (41%), tibial recurvatum (33%), and tibial varus (22%). Although standing hip-to-ankle radiographs were the most common radiographic assessment of growth disturbance, most studies inadequately reported the clinical and radiographic methods of assessment for growth disturbance. Additionally, only 35% of studies explicitly followed patients to skeletal maturity.
This systematic review described significant variability in the reporting and monitoring of growth-related complications after ACL reconstruction in skeletally immature patients. The incidence of LLD and angular deformity appeared to be low, but the quality of research was not comprehensive enough for accurate assessment.
CRD42019136059 (PROSPERO).
生长发育障碍是骨骼未成熟患者前交叉韧带（ACL）重建术后一种少见但可能严重的并发症。
描述儿科ACL文献中如何评估术前骨骼成熟度和剩余生长量，并全面综述术后生长发育障碍的发生率、报告情况及监测情况。
系统综述；证据等级，4级。
本综述纳入了报告骨骼未成熟患者ACL重建术后临床结局原始研究的文献。提取患者特征、手术技术、术前骨骼成熟度或剩余生长量评估以及术后生长发育障碍评估。
共有100项研究符合纳入标准。所有研究均报告了实足年龄，28项研究（28%）评估了骨骼年龄。共有44项研究（44%）采用坦纳分期，12项研究（12%）术前拍摄了站立位髋至踝关节X线片。共有42例患者（2.1%）术后出现下肢长度差异（LLD）>10 mm，其中9例患者（0.5%）LLD>20 mm；此外，11例LLD患者（0.6%）接受了生长调节。总体而言，缩短是最常见的畸形，但在接受全骨骺技术的患者中，过度生长的报告更为频繁。大多数LLD累及股骨（83%）。共有26例患者（1.3%）术后出现角度畸形≥5°，其中9例患者接受了生长调节。最常见的畸形是股骨外翻（41%）、胫骨后凸（33%）和胫骨内翻（22%）。虽然站立位髋至踝关节X线片是评估生长发育障碍最常用的影像学检查，但大多数研究对生长发育障碍的临床和影像学评估方法报告不足。此外，只有35%的研究明确随访患者至骨骼成熟。
本系统综述描述了骨骼未成熟患者ACL重建术后与生长相关并发症的报告和监测存在显著差异。LLD和角度畸形的发生率似乎较低，但研究质量不够全面，无法进行准确评估。
CRD42019136059（PROSPERO）。
